Are We Facing a Family Caregiver Shortage?

1978. Some of Julie's earliest memories are of her grandmother, who came to live with her family after suffering a stroke. Julie's aunts, uncles and cousins all lived nearby, so there was always someone to help out if Grandma needed a ride to the doctor or to church. With the help of family, Grandma seldom missed a band concert, graduation ceremony or Little League game until she suddenly passed away at age 82.

2018. Julie, an only child, is now struggling to care for her own widowed mother, who has early-stage Alzheimer's disease and complications from diabetes. Mom recently moved into Julie's Chicago home; before that, Julie frequently flew to Mom's place in Kentucky. These days, Julie spends most of her spare time on Mom's care and has to take off work sometimes. But there are no other family members to help.

20?? Her experience with Mom makes Julie think about her own future. She never married. Career-oriented, she's relocated several times for work, so she doesn't feel as connected to the community as she would like. At 47, her health is pretty good, but like her mom and grandmother, she has high blood pressure. She wonders what her own life will be like as she ages.

Julie's situation is far from unique. As North American society changes, so does caregiving. While family members once provided everything from hands-on care to transportation to healthcare management and assistance during hospitalizations, this is changing.

Our elder care organizations on every level need to be aware of this, say experts. "All of these systems are set up for people who are part of dense family networks," said Rachel Margolis, a sociology professor at Western University in Ontario. "We haven't really thought seriously about how our mindset is going to adjust with much greater numbers of people who are not going to have these connections."

Three reasons for the big shift

1. Our lower birth rate. Right after World War II, families had lots and lots of children — but those kids, the baby boomers, didn’t follow in their parents’ fertility footsteps. The availability of birth control, the changing role of women, and awareness of the impact of overpopulation drove down family size among boomers.

2. More people are divorced, or never married. Margolis and her team noted that the divorce rate for people aged 55 – 64 has more than doubled in the past 25 years. The remarriage rate has dropped and there’s an increase in people who never married or partnered, as well. This means more people are entering their senior years living alone.

3. Increased mobility. Once upon a time, Americans tended to stay in the towns where they grew up, but that is less often the case today. When seniors need care, chances are that their kids have moved across the country to seek work opportunities or to live somewhere they like better. And seniors themselves often relocate to follow their retirement dream.

The result: fewer caregivers … and lots more seniors

In 1960, there were far more children than older folks. Today, the shape of our population is quite different! Click on the graph to learn more. (Image: The U.S. Census Bureau)

Meanwhile, just as the caregiver pool is shrinking, the percentage of older people who are likely to need care is growing and will continue to grow for some time. A March 2018 report from the U.S. Census Bureau tells the story. Demographer Jonathan Vespa reported that by the year 2030, 20 percent of all people in America will be older than 65. "The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in U.S. history," he explained. "By 2035, there will be 78 million people 65 years and older compared to 76.4 million under the age of 18."

And we're living longer. According to the Population Reference Bureau, the average life expectancy in the U.S. has increased from 68 years in 1950 to 79 years today, with plenty of people living to be older than that. Centenarians are the fastest-growing age group! Yet for most of us, those "bonus years" will be marked with health challenges and disabilities that mean we will need some help.

For caregivers, this senior boom means a heavier load. There will be more seniors, with fewer hands to pitch in. The Center for Retirement Research at Boston College reports that 20 percent of us will end up providing care for elderly parents and grandparents — and we'll spend an average of 77 hours per month at it!

And we're hearing more about "kinless" seniors, often called "elder orphans." A growing number of seniors will simply have no family caregivers at all to help. Despite the warnings from demographers, our senior support system is moving slowly to address this trend, so in the foreseeable future, chances are that we'll be pretty much on our own.

So it's important to plan. Here are things to think about sooner rather than later. Think of these items as advice from your older self!

We can plan ahead even without family. We might ask a trusted friend to serve as our financial and/or health representative. Many professionals can help, among them geriatric care managers (now often called "aging life care professionals"), elder law attorneys, financial advisors and estate planners. Your local Area Agency on Aging may be able to point you in the right direction. Financial planning is vital, because care is expensive.

Think about where to live sooner rather than later. You might turn your nose up at the idea of a senior living community, but try to see it from the point of view of your older self. Or maybe your heart is set on "aging in place," staying in your long-time home? Would your home be suitable if you couldn’t drive or needed to use a wheelchair? Could home modifications make it a better fit for your future needs? Will you be able to afford to pay taxes and keep up with maintenance?

Make a plan to avoid social isolation. Loneliness is torture for our species. Maybe you do most of your socialization at work; what will happen when you retire? Some aging baby boomers report that having a large, durable circle of friends is just as valuable and supportive as having adult children. But creating an alternative family requires cultivation. Start setting up social networks early, through volunteer service, a purposeful collection of friends, and all-important intergenerational connections.

Make a plan for care. We all like to think we'll be like the seniors in the active retirement community ads, zipping around on our motorcycle or playing tennis. But odds are if we live long enough, we'll be dealing with health conditions such as arthritis, osteoporosis, vision or hearing problems, cardiovascular or lung disease, or memory loss. Most of us will need care at some time.

Sometimes it's best to move to a skilled nursing facility or assisted living community. But skilled nursing care can also be provided at home. And at a lower cost, nonmedical home care services promote the well-being of seniors at home in many ways.

Planning ahead for home care

When we're younger, it's natural to avoid thinking about the time when we will need help like this. We value our independence and think, "The last thing I would want is a stranger in my home!" But do your future self a favor and imagine these very common care needs that might arise:

Assistance with personal and household care. Many tasks that we take for granted can be challenging or impossible if we're living with arthritis, a heart condition, vision loss or other conditions that are so common among older adults. A professional caregiver can help you with bathing, dressing and grooming, as well as providing housekeeping help.

Transportation. We rely on our cars so much — but the changes of aging can mean it's no longer safe for us to drive and we can quickly become "housebound." We could take a cab, or take advantage of the senior transportation services many communities offer. But how much more convenient and safe it would be to have our in-home caregiver take us where we need to go!

Nutrition assistance. Eating right can make such a difference in our physical and cognitive health as we grow older. In April 2018, the Journal of the American Medical Association noted that eating well can stave off frailty for years! But disabilities make it hard to cook and go to the market. Professional caregivers can grocery shop, prepare meals and snacks as recommended by our doctor if we're on a special diet — and best of all, make foods we love.

Care coordination. According to the National Council on Aging, 80 percent of older adults have at least one chronic disease, and 77 percent have two. In our later years, we'll most likely have several different doctors, take multiple medications, and perhaps have a medical regimen to follow at home. Professional caregivers can help us keep track of and get to appointments.

An extra measure of confidence. Mobility challenges, vision loss and forgetfulness can make us feel nervous about being safe when physically active — just at the point in life when exercise is more important than ever. Having a caregiver on the spot provides confidence that there will be a steadying hand if we lose our balance, and reassurance that help will be on hand if we were to fall.

Memory care. University of Southern California experts say that the number of people living with Alzheimer's disease is on track to nearly triple, from 5 million today to 14 million by the year 2050. Lifestyle choices lower the risk, but there's no guarantee. We need to plan for the possibility. Consider that in the early stages, most people with dementia do best in familiar surroundings. It's important to hire a caregiver who has been specifically trained to assist people with memory loss.

Choosing a caregiver

Just as we're facing a shortage of family caregivers, experts say there may be a shortage of professional caregivers, as well. It's important to hire through an agency that is well-respected and attracts and retains the best caregivers with training and an excellent work environment.

Next month: Soon the U.S. will have more seniors than children. Other countries have already passed that mark. How are older adults in these Asian and European countries dealing with the shift? Check out some innovative programs and resourceful seniors in the July 2018 issue of the Caring Right at Home online newsletter.

Right at Home, Inc. is a national organization dedicated to improving the quality of life for those we serve. We fulfill that mission through a dedicated network of locally owned providers of in home care services.

Poll

Experts predict an increasing family caregiver shortage. What do you think about your own future care needs?

I am confident that family members will be able and glad to help me.

I have family, but I haven’t thought about how much they could help.

I think I’ll be on my own, but I haven’t planned.

I am creating a plan for care that includes professionals.

I am already receiving care.

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